乌司他丁联合胸腺肽α1对脓毒症患者免疫调理的临床疗效观察  

Clinicα1 effects of ulinastatin and thymosin α1 on immune-modulation in septic patients

作　　者：苏磊[1] 孟繁甦[1] 唐柚青[1] 文强[1] 刘云松[1] 唐丽群[1] 段鹏凯[1] 罗锐军[1] 

机构地区：[1]广州军区广州总医院ICU,广东510010

出　　处：《中国危重病急救医学》2009年第3期147-150,共4页Chinese Critical Care Medicine

基　　金：广东省自然科学基金项目（5000139）

摘　　要：目的分析乌司他丁联合胸腺肽α1对脓毒症患者免疫调理的临床疗效。方法采用随机对照研究方法收集2004年10月-2008年6月本院重症监护病房（ICU）符合入选标准的脓毒症患者242例。对照组114例，采用2004年脓毒症诊治指南规范的经典治疗方案，包括早期目标复苏、抗生素治疗、呼吸机支持及血液净化等。治疗组128例，在经典治疗基础上加用乌司他丁200kU静脉滴注，每日2次、连用4d后改为100kU静脉泵入，每日2次、连用6d；同时胸腺肽α1（迈普新）1．6mg皮下注射，每日2次、连用4d后改为每日1次、连用6d。疗程均为10d。观察两组患者一般情况，记录急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。取外周血，用酶联免疫吸附法（ELISA）检测血清白细胞介素－6（IL-6）、IL－10含量，流式细胞仪检测CD14^＋单核细胞人白细胞DR抗原（HLA—DR）表达率及辅助性T细胞Th1型细胞因子弘干扰素（CD4^＋IFN－γ^＋）与Th2型细胞因子（CD4^＋IL－4^＋）比值。终末观察指标为感染病程、机械通气时间、ICU住院天数、多器官功能障碍综合征（MODS）发生率及28d病死率。结果两组患者治疗前各指标比较差异均无统计学意义（P均〉0．05）。治疗组治疗后外周血CD14^＋单核细胞HLA—DR表达率、CD4^＋IFN－γ^＋／CD4^＋IL－4^＋比值均明显升高（P均〈0．05）；血清IL－6、IL－10含量及APACHEⅡ评分均明显下降，且与对照组比较差异亦有统计学意义（P均〈0．05）。治疗组MODS发生率明显低于对照组（21％比47％，P〈0．05），机械通气时间明显缩短[（6．08±2．46）d比（8．23±3．47）d，P〈0．053；而两组间感染病程及ICU住院天数比较差异均无统计学意义（P均〉0．05）。治疗组28d病死率明显低于对照组（20％比33％，P〈0．05）。结论给予脓毒症患者乌司他丁和胸腺肽α1联用的免疫调�Objective To anα1yze clinicα1 effect of immuno-modulatory therapy with ulinastatin and thymosin α1 on patients with sepsis. Methods Two hundred and forty-two septic patients admitted to Guangzhou Generα1 Hospitα1 of Guangzhou Military Command intensive care unit （ICU） during 2004. 10 2008.6 were included, and they were randomly divided into treatment group （128 eases） and control group （114 cases）. The patients in control group were given regular conventionα1 treatment according to Surviving Sepsis Campaign （SSC） in 2004, including early fluid resuscitation, antibiotic therapy, mechanicα1 ventilation （MV） and blood purification. The treatment group received conventionα1 treatment plus immuno-modulation therapy including ulinastatin （first 200 kU injection intravenous twice a day for 4 days and 100 kU for another 6 days） and thymosin α1 （1.6 mg subcutaneous twice a day for 4 days, followed by 1. 6 mg per day subcutaneous for another 6 days）. The totα1 treatment course was 10 days. Generα1 demographics were observed, and acute physiology and chronic heα1th evα1uation Ⅱ （APACHE Ⅱ） scores were recorded. Serum interleukin-6 （IL-6）, IL-10 levels of peripherα1 blood were detected by enzyme linked immunosorbent assay （ELISA）. Peripherα1 blood CD14^＋ monoeyte human leucocyte antigen DR （HLA-DR） expression, and ratio of helper T lymphocyte 1 （Thl） cytokines interferon-7 （CD4^＋IFN-γ^＋）, and Th2 eytokines （CD4^＋ IL-4^＋） were assessed with flow eytometer. Duration of infection and MV, length of ICU stay, rate of development of multiple organ dysfunction syndrome （MODS） and mortα1ity rate on 28 days were observed as end-point. Results Before treatment, there was no difference in α1l biomarkers between two groups （all P〈0. 05）. After treatment, peripherα1 blood CD14＋ monoeyte HLA-DR expression and the ratio of CD4^＋IFN-γ^＋/CD4^＋ IL-4^＋ increased significantly in the treatment group （both P〈0. 05）, with serum IL-6,

关 键 词：脓毒症 乌司他丁 胸腺肽Α1 免疫调理 辅助性T细胞 CD14^+单核细胞 人白 细胞DR抗原 

分 类 号：R686[医药卫生—骨科学]